Stereotactic Body Radiotherapy Combined with Transcatheter Arterial Chemoembolization versus Stereotactic Body Radiotherapy Alone as the First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Meta-Analysis and Systematic Review

Abstract

Background: The superiority of stereotactic body radiotherapy (SBRT) combined with transcatheter arterial chemoembolization (TACE) compared to SBRT alone as the first-line therapy for unresectable hepatocellular carcinoma (HCC) remains unclear. We conducted this meta-analysis to compare the efficiency and safety of SBRT combined with TACE (ST group) and SBRT alone (SA group). Methods: We searched PubMed, Ovid Medline, Web of Science, Scopus, The Cochrane Library, ScienceDirect, EMBASE, Google Scholar, and CNKI (China National Knowledge Infrastructure) for related studies. We analyzed overall survival (OS), local control survival (LCS), progression-free survival (PFS), the response rate and adverse effects (AEs) between the 2 groups. Results: Ten articles were included, with a total of 980 patients. The results showed that the ST (SBRT + TACE) group had a longer OS (95% CIs 0.60-0.85, p = 0.0002), a higher 5-year OS rate (95% CI 1.01-2.04, p = 0.04), a higher rate of complete response (95% CI 1.08-1.90, p = 0.01), and a higher disease control rate (95% CI 1.02-1.16, p = 0.02) than the SA (SBRT alone) group. No significant difference was found in LCS, PFS and total AEs of all grades and grades 3-5 AEs between the 2 groups. In the subgroup analysis, the patients with HCC + PVTT or treated with SBRT followed by TACE in the ST group had the same OS as those in the SA group, and the patients in the ST group had a higher incidence rate of leukopenia and fever than those in the SA group. Conclusion: SBRT + TACE appears to be more effective than SBRT alone in treating unresectable HCC. However, its higher incidence rate of leukopenia and fever need to be monitored. and PFS. When HRs with 95% CIs were < 1, the result supports the superiority of ST. We extracted HR data directly from Buckstein et al. [21]. We extracted data from Kaplan-Meier curves using methods described by Tierney et al. [22]. Risk ratios with 95% CI were used to analyze the dichotomous variables (response rates, AEs). We conducted subgroup analyses of OS, LCS, and PFS to determine whether the results changed according to nation, patient type, treatment priority, tumor stage, Child-Pugh class, and Eastern Cooperative Oncology Group (ECOG) performance status. Heterogeneity was evaluated using the I 2 statistic and χ 2 test. If I 2 was > 50% or p was < 0.1, the fixed effects model was used, reflecting the lack of significant heterogeneity; otherwise, we used the random effects model. The sensitivity analysis in this study was performed with STATA. Begg's rank correlation and Egger's linear regression tests were used to evaluate the publication bias. Statistical significance existed when p was < 0.05.

Liver Resection Combined with Radiotherapy versus Liver Resection Alone in the Treatment of Hepatocellular Carcinoma: A Population-based Study

“…Several recent studies documented that HCC patients receiving radiotherapy combined with other treatments had longer survival than those treated with radiotherapy alone [19][20][21]. A meta-analysis that compared the e cacy of TACE combined with radiotherapy with TACE alone treatment in patients with portal vein tumor thrombus (PVTT) demonstrated that the combined treatment yielded a higher objective response rate (ORR) and better survival bene ts than the TACE alone treatment [22].…”

Preoperative Versus Postoperative Transarterial Chemoembolization on Prognosis of Large Hepatocellular Carcinoma

“…TACE inhibits tumor growth by blocking tumor blood supply and creating hypoxia which induces tumor necrosis. A number of studies have shown that TACE can improve survival outcomes in patients with unresectable HCC [23][24][25]. Other studies have also demonstrated that patients with large HCC can benefit from preoperative TACE [26,27].…”

Stereotactic body radiation therapy for hepatocellular carcinoma: From infancy to ongoing maturity

“…suggests higher response, local control, and survival rates with TACE and SBRT vs. SBRT alone. 78 Randomised studies comparing TACE with TACE and SBRT in unresectable HCC are ongoing ( NCT03895359 and NCT02794337 ).…”